I'm new here and I could use some advice...

[AFGNCAAP (imported)]

Hey everyone. It's always difficult to know where to start when it comes to stuff like this, but I guess at the very least I should give a little back story. I have suffered from anxiety/depression/OCD ever since I was a teenager. Over the years I tried many things to cope, including talk therapy, and conventional psychiatric medications. Nothing was really effective, and even though I did manage to squeak my way past high school, when it came to college I wasn't able to keep it together. I got behind in everything, quit going to classes, and dropped out after one semester.

You know, I have learned from experience that the medical community is basically useless if they don't already know the solution to your problem. I have probably worked with more doctors than you can count over the years, and not one of them has been any more insightful than your average visit to Wikipedia. Eventually it's hard not to decide to take things into your own hands. So that's more or less what I did. I tried alternative medicine, vitamin supplements, acupuncture, you name it. Doing that for a while makes you realize that as worthless as the medical community can sometimes be, you could do worse.

Eventually, after trying just about everything else, I finally attempted messing with my hormones. The first thing I did was to try to raise my testosterone. Conventional wisdom is that low testosterone can cause anxiety and depression, and even though my testosterone was not technically low, it was on the low end of the spectrum. I attempted to raise my testosterone by taking pregnenolone, exercising, and making adjustments to my diet. The result was actually pretty dramatic, in that my anxiety started to feel worse than it had in a long time. You'd think that might have discouraged me, but up until that point, this was the most significant result I'd gotten from anything I'd tried. For better or worse, even benzodiazepines hadn't really made much of an impact. A lot of the stuff I took created plenty of side effects unrelated to the anxiety, but did nothing to the anxiety itself. Knowing higher testosterone raised my anxiety was a real result, and a useful one at that. It led me to the pretty obvious conclusion that lowering my testosterone should lower my anxiety.

I'd like to point out that a little time spent in Google will tell you my experience is not unprecedented. The problem is, most doctors would never assume that when you have problems associated with low testosterone, and your testosterone actually is low, making it even lower would be a good idea. Then again, sometimes your body is smarter than you think. Maybe if it's having difficulty dealing with the testosterone, for whatever reason, it would want to make less of it. But even then, maybe it needs a little help. That was pretty much my experience. I tried spironolactone for a while, and it definitely did help, but due to concerns with it messing too much with my blood pressure, I wasn't able to get my dose high enough to really tank my testosterone levels. Then I tried Androcur, and even at the relatively low dose of 50mg a day, the results were pretty dramatic. I had the lowest anxiety levels I'd experienced in years. When I actually had my testosterone tested again, I had practically none left in my system.

I'd like to stress that unlike a lot of people here, I didn't really start out with any preconceived notions that testosterone was a bad thing. Everything I had ever been told up until that point, led me to believe that not having any testosterone would completely suck. The fact is, that at least in my case, it did not. The only noticeably negative side effect I can say that I've had after spending nearly a year with no testosterone, is that I'm more sensitive to cold. That's it. I can't even count low libido, because even though it is lower, I can still get it going when I want to. And honestly, not being preoccupied with sex is a much nicer experience than I could have ever imagined. I don't hate sex, but I sure don't need to be thinking about it constantly even when I'm not having it. I think maybe a lot of men might actually feel the same way if only their hormones would give it a rest once in a while. But, I digress.

Taking Androcur is a nice thing, but there are a few problems. First of all, I'm still having some blood pressure issues with it, although not nearly as badly as with the spiro. Also, I know it's not a permanent solution, because it's too hard on your liver to take it forever. And finally, it increases my risk of blood clotting, which is really the last thing I need. Before I try to pull myself together and get on with my life, I want to get off this stuff. I think knowing what I know now, an orchiectomy is really the only way to go. There is no way, under any circumstances, I am going to let my testosterone levels go up again. I tried it once, by backing off the medication for a while, just to see what it would do. Needless to say, it was not in the least bit helpful for my anxiety levels, and I felt like I had to get back on the stuff well before my testosterone levels got back to normal.

I already talked to a urologist about getting the procedure done, and he was unhelpful to say the least. Honestly, I think he must have thought I was nuts or something. He seemed really put off when I brought the subject up with him, but he did refer me to a psychologist, saying that he couldn't do the procedure without their approval. At the time he made it sound like I just had to go in, get a proverbial green stamp, and walk out. The truth of the matter was, the person he referred me to was completely unwilling to hear me out. All it seemed like she was able to do was regurgitate the side effects of low testosterone, even as I explained to her I was perfectly aware of them, as my testosterone was already more than low enough to know how it would affect me. After about forty-five minutes of talking to a brick wall, I got fed up and walked out.

This all puts me in a pretty difficult position. I know what needs to be done, but I don't know of doctor willing to do it. I'm sure a lot of you guys have been there, but I think I may be one of the few who actually needs my testosterone low as a prerequisite for being able to function. Any advice you can give me would be greatly appreciated. I live in the Minneapolis/St. Paul area, and I don't really have the money to travel, so any recommendations of a local doctor who might be sympathetic would be extremely helpful. Barring that, I think I may need to try what this person tried (http://www.eunuch.org/forums/showthread ... -the-works.). That being, to damage my testicles enough with alcohol that it gives a surgeon a medically valid reason for removing them. I'm not crazy about the idea, for safety reasons if nothing else, but I am low on options. I just hope that tipping my hand by having already asked for an orchiectomy won't make things more difficult than they have to be.

[raymar2020 (imported)]

Welcome to the Zoo. Having read your post, I would say that the therapist you saw should have her license yanked. Its obvious that you have some issues at work, and the only way to really reach any conclusions about how best to proceed is to listen to what you have to say. Seek out another therapist, and frankly not one that is into gender issues. From all you have said, it seems that you have come to the conlusions you have thru thoughtful, and sane self treatment for your problems.

Ask your PCP to recommend a good therapist. If that one doesn't wotk out ask family or friends to recommend someone that they found helpful. Keep trying them , til you get one that will actually listen to you.

Raymar

[purpletomato (imported)]

Hi there,

Good to hear your story. It's nice to hear yet another experience indicating that testosterone has "cons" as well as "pros". I can't help with therapist recommendations, but you might try looking at Yelp reviews of therapists. I imagine the better ones are usually better educated, and hence slightly more likely to listen to you. You might be able to do a little internet research for each -- find the school they went to (is it liberal arts or conservative?), what their religion is (not always a barrier, but likely a factor), etc. I'm not sure on age or gender -- maybe try different combinations.

Good to hear you're approaching things with a reasonable, scientific approach; wish you all the best. I don't know how long you've been on Androcur, but it might take a little while before you feel the full effects.

If things work out, send your old therapist and urologist a note -- tell them they were wrong. Do everyone a favor, and write some negative reviews online. Even if people don't sympathize with your position, hearing that a therapist doesn't listen to you is useful information.

[AFGNCAAP (imported)]

Thanks for the advice guys. I did look at some reviews as you suggested... and nothing looked particularly promising. No psychologists in my area got enough good reviews for me to draw any real conclusions. I'm not even sure how this whole thing would work even if I was able to find a good psychologist. I know the urologist can't order the procedure without a medically valid reason, and what my opinion is on how testosterone affects me apparently doesn't count. I'm assuming a psychologist could in theory grant me an exception, but they'd need a way to justify it too. I'm just not sure what that would be. Lowering testosterone to decrease anxiety does go against conventional medical wisdom, and I'm not sure if there are any psychologists out there who would be willing to okay an orchiectomy as a treatment. I'm going to talk it over with my primary care doctor the next time I need my bloodwork done, and see what he thinks. He is actually a great doctor who has been very understanding of the frustration I've had in the past years getting my issues dealt with. He generally does know what doctors to recommend, but this whole thing is a little out of his area of experience. In the mean time, if anyone has any further suggestions, by all means let me know.

[raymar2020 (imported)]

Document your experiences. Keep a journal of how wach day is for you. Keep track of your testosterone levels, and report to the journal how you feel at each level. Be open with your PCP, who it sounds like is a caring and open minded individual. Ask him for some suggestions about a therapist who would be open minded as well.

The truth is that there are myriad reasons why a therapist would agree to write a consent letter for you to have an orchiectomy, from transgender, to body integrity disorder. Finding that you have seriously negative effects from Testosterone, could well be added to that list as well. For the most part , therapists who deal with gender issues are not trying to be road blocks, but rather to be sure that the treatment is the right one.

Raymar

[janekane (imported)]

Noting that your profile has you being in Minnesota, and my having lived in Minnesota, and my having received rather decent and, in my view, appropriate care at the Mayo Clinic in Rochester, and some relatives having received, in my view, appropriate care at the University of Minnesota, in the Twin Cities, I wonder whether the way I went about getting what I regard as proper care might be helpful.

Most of my care has been in "research" hospitals, ones like Mayo Clinic uses, or ones in major research universities, such as the University of Minnesota, Twin Cities, places where scientific medical thinking is at least as prevalent as is clinical medical thinking.

I have mentioned on another thread, the article, The Neuroscience of Identity: How 'jumping genes in the brain make each person unique in the March, 2012 Scientific American. In a research and teaching hospital or medical center, it may be vastly easier to find urologists, psychologists, psychiatrists, and such who are comfortable with, and familiar with, the nature of biological diversity, and who may also be familiar with the 2011 revisions of the World Professional Association for Transgender Health Standards of Care, in which male-to-eunuch is an acceptable and valid condition for which proper care (like orchiectomy) is wisely deemed medically necessary for some people (like me, for example).

Perhaps your primary care physician can make a useful referral, if transportation is not an unduly difficult barrier.

For many years, physicians were taught, "When you hear hoofbeats, think horses, not zebras." That would be sound medical policy if zebras did not actually exist.

Zebras do exist.

Perhaps you can locate a copy of the March, 2012, Scientific American and perhaps you will be able to find physicians and such who can grasp its meaning regarding the biology of the diversity of human sexuality, gender, and response to hormones.

[Losethem (imported)]

What is your medication mix? You state depression and other issues, but what did the medical community give you? Sometimes the "cure" is worse than the "disease".

I'll try to provide some insights, but without knowing your medication mix and the reasons those meds were given to you, it's hard to formulate a reponse.

I do want to help, but to do so I need a bit more information.

--LT

[JesusA (imported)]

You need a therapist who is comfortable with gender issues. Your profile indicates that you live in Minnesota. The headquarter

s of the World Professional Association for Transgender Health

is in Minneapolis and there are more good gender therapists in that region than most anywhere else in North America. A telephone call to WPATH may set you in the right direction.

[AFGNCAAP (imported)]

Noting that your profile has you being in Minnesota, and my having lived in Minnesota, and my having received rather decent and, in my view, appropriate care at the Mayo Clinic in Rochester, and some relatives having received, in my view, appropriate care at the University of Minnesota, in the Twin Cities, I wonder whether the way I went about getting what I regard as proper care might be helpful.

I think checking out the Mayo Clinic definately sounds like a good idea. Since I have approached this whole process with a scientific mindset, dealing with doctors who are used to doing the same has a very good chance of working to my advantage. I'm not as sure about the U of M, because I have no idea what it would take to get admitted to a place like that for medical treatment. I'll keep it in mind, but I can probably get a re

ferral to a doctor at the Mayo with a lot less hassle.

What is your medication mix? You state depression and other issues, but what did the medical community give yo

u? Sometimes the "cure" is worse than the "disease".

It's not really a medication mix. Right now I'm taking Androcur and nothing else. I never at any point tried more than one medication at once for anxiety/depression because nothing I tried ever worked well enough for me to keep taking it for very long. I did give the things I tried a fair amount of time to work, although I dropped a few things relatively quickly due to side effects. Actually, the only thing I ever tried that I took for longer than three months was Kava extract (http://en.wikipedia.org/wiki/Piper_methysticum). I took it for about a year because it actually did make me feel less depressed, with few if any side effects. The reason I quit taking it was that I didn't feel like it was neccesary anymore when I switched to Androcur. Well that, and it never did do that much for my anxiety, and I was starting to build up a tolerance for it.

In general, my experience with prescription medications for anxiety is, they all suck. SSRIs didn't work, and they made me feel too loopy to concentrate half the time. Benzodiazepines just plain didn't do anything. Azapirones didn't work, and also made it difficult for me to concentrate. I even tried an anti-psychotic (Risperidone), but it had such a severe effect on my ability to think that I ended up in urgent care because I thought I was having a bad reaction too it. I've tried a lot of medicati

ons over the years, and I'm reasonably sure that what I'm doing now works better than anything else available.

You need a the

rapist who is comfortable with gender issues. Your profile ind

icates that you live in Minnesota. The headquarter

s of the World Professional Association for Transgender Health

is in Minn

eapolis and there are more good gender therapists in that region than most anywhere else in North America. A telephone call to WPATH may set you in the right direction.

I'm not really sure if what I'm dealing with qualifies as a gender issue. I hate testosterone pretty badly, but it's not because I feel like a eunuch in a man's body or anything. At the very least, I'm going to try my luck at the Mayo before going that route. I'm not totally against it, but just based on the principle of the thing, I feel like I shouldn't have to pretend to have a gender issue just to get what I feel is a valid medical treatment for my problem.

[janekane (imported)]

I did not need a referral to be seen and treated at the Mayo Clinic. It has been several years since I was there, and, at that time, all I needed to do was to walk in and start describing my medical concern; they figured out who I could, as best they could figure, most wisely see. Whether Mayo has continued to deal with walk-ins as they did then, I have not investigated.

If "horses" means people with gender dysphoria, and '"zebras" means someone not gender-dysphoric (not transsexual or transgendered, and not interested in changing one's "social presentation," then, I am willing to allow that you, and I, may be somewhat like different sub-species of "zebra" in a medical community which is only beginning to learn about "zebras."

There are those who have put forth the view that clinical medicine is the work of technicians; much as others have put forth the view that "engineers are handbook jockeys." If I want to understand how to use a wide-flange beam as a horizontal load-bearing structural element, and if the load is sufficiently uniformly distributed, a "has it all" handbook like Hicks may be the one handbook I need. The problem with Hicks, if load is not at all uniformly distributed, is, one might change the design of walkways in a hotel, such that the walkways collapse under loading which would not have taken down the original design. Yeah, that one made headlines not so many years ago.

For so long as routine medical diagnosis is based on "dichotomous taxonomic trees" or similarly divided classification schemes, much of the real human biological diversity which is, methinks essential for the existence of humans will be classified as disease, meaning being labeled abnormal instead of, much more accurately, aspects of the normal realm of human biological diversity.

Which is why I mentioned that Scientific American article; it provides a pathway toward accepting that you can be who you are, and not be what someone who does not understand you believes you are.

During my life, I have known identical twins. Only, they were not identical people.